Prescription Pattern Of Drugs Research Articles

A prospective study on the prescription pattern of Antibiotics and oral hypoglycemic drugs among Hospitalized patients with diabetic foot ulcers

Diabetic foot complications encompass neuropathy, ischemia, and infection-induced tissue breakdown. Individuals with diabetes carry a 20% high susceptibility to foot ulcers due to neuropathy. These ulcers, from peripheral neuropathy or arterial disease in diabetes mellitus (DM) patients, can lead to necrosis and gangrene. Importantly wound healing stands as the primary goal in treating diabetic foot ulcers (DFUs), with meticulous glucose control and suitable antibiotic administration.

Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery.

Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.

Real-world drug prescription patterns and mortality risk in patients hospitalized with acute heart hailure: impact of multimorbidity and heart failure phenotype

Abstract Background Real-world data on the impact of multimorbidity and of heart failure (HF) phenotype on longitudinal drug prescription patterns and dosing of guideline-recommended HF drugs and on mortality risk following acute HF (AHF) is sparse. Purpose We studied prescription rates (PR) and dosing of renin-angiotensin-system inhibitors (RASi), betablockers (BB), and mineralocorticoid-receptor antagonists (MRA) in patients hospitalized with AHF by comorbidity burden (CB) and HF phenotype on admission, at discharge, and at 6-month follow-up (6MFUP), and determined 12-month mortality risk. Methods Consecutive AHF patients enrolled on a 24/7 basis in a single-center prospective cohort study from 8/2014 to 2/2020, who had their left ventricular ejection fraction (LVEF) measured while in hospital, were eligible. Proportions of patients taking each HF drug class on admission, at discharge and at 6MFUP were determined in subgroups according to LVEF (&amp;lt;50% versus ≥50%) and CB (number present of: hypertension, chronic kidney disease, diabetes, anemia, chronic lung disease, psychiatric disorder, malignancy, atrial fibrillation, coronary disease, peripheral vascular disease, hypercholesterolemia). Results Of 943 patients, 47% had a LVEF &amp;lt;50%, and 53% had a LVEF of ≥50% (Table). CB was similar in both groups (p = 0.197), but patients with LVEF ≥50% were older and more often female (Table). Average PR of the 3 HF drug classes were higher in patients with LVEF &amp;lt;50% compared with ≥50% (mean count 2.2±0.8 vs. 1.7±0.8, respectively, p&amp;lt;0.001), but PR trajectories were similar: In patients with fewer comorbidities, PR were lower on admission but showed the greatest increase during the hospital stay (in particular for BB and RASi). PR improved in all patients irrespective of CB and reached a maximum at discharge (Figure). Still, many patients remained on suboptimal drug doses (irrespective of CB), and PR tended to decrease again at 6MFUP, except for MRA, which were often not prescribed at all even in patients with LVEF &amp;lt;50%. Absolute 12-month mortality risk was similar in the patients with LVEF &amp;lt;50% and ≥50%, but CB and number of HF drugs prescribed at discharge impacted significantly on 12-month mortality risk only in patients with LVEF &amp;lt;50% (Table). Conclusion In this study, PR of HF drugs increased during the in-hospital period, irrespective of HF phenotype. Neither PR, nor daily doses improved further after discharge. Prescription patterns were similar across spectra of LVEF and CB, but only in patients with LVEF &amp;lt;50% the number of comorbidities and of prescribed HF drug classes impacted mortality risk significantly. Given that timely implementation of foundational HF therapies (which today include also SGLT2 inhibitors) may improve outcomes, reasons for underprescription (e.g., suspected intolerability of individual drug classes or structural deficits of post-discharge HF management) in real world warrant further study and better control.TableFigure

Biochemical and Hematological Patterns of Hospitalized COVID-19 Patients in Mongolia

Objectives: The impact of COVID-19 prompted a race to find a treatment that would reduce its mortality. This study aimed to analyze how the clinical and laboratory characteristics reflect the disease process and progression of COVID-19 cases in hospitalized patients of Mongolia, which could be informative in managing patients with COVID-19. Methods: A cross-sectional study was conducted on the prescription patterns of drugs given to hospitalized patients diagnosed with COVID-19. A total of 1012 participants were recruited in the study. These were identified from the reported positive cases by polymerase chain reaction or antigen reactivity performed in Ulaanbaatar. Result: A total of 1096 patients participated in this study. The mean age was 51.86 ± 16.98 for male patients and 52.23 ± 16.4 for female patients. It has been revealed that there are statistically significant differences between male and female patients. RBC was 4.56 ± 0.79 M/ UL and 5.08 ± 1.36 M/UL, men and women respectively. The levels of C-reactive protein (CRP) in female COVID-19 patients were significantly higher (46.75 ± 72.83 mg/dL) compared to male patients (33.94 ± 47.96 mg/dL). The platelet count (PLT) was 245.32 ± 77.71 for male patients, while there was a significant reduction in PLT count in female patients (229.30 ± 71.59). Conclusions: Patients with COVID-19 in Mongolia appeared to remain in the hospital for 6.86 ± 2.43 days, shorter than in other countries. Hematological analysis showed that female patients had elevated C-reactive protein levels and decreased PLT count.

Evaluation of prescribing patterns using WHO core drug use indicators in a pediatric hospital of Kabul Afghanistan: A prospective cross-sectional study

BackgroundThe global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan. MethodsA prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities. ResultsThe average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%). ConclusionThe study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics.

A pilot study: Drug utilization pattern and prevalence of micro and macrovascular complication in type 2 diabetes patient

Background: Diabetes mellitus is a chronic metabolic disorder resulting from the deficiency of insulin secretion and insulin resistance. Currently, there is a death of nationwide data regarding the prevalence of micro and macro complications and drug utilization patterns. This study will help health-care professionals approach management more aggressively to prevent complications. Objectives: To assess the risk factors associated with complications in diabetes patients, and to determine the pattern of drug prescription among type-2 DM patients patterns at Virudhunagar Medical College &amp; Hospital. Methods: This is a Prospective, prescription-based, and observational study. A sample size of 50 was selected systematically. Data were collected from patient case records and Prescriptions. The obtained data were entered in the structured patient profile form, and the filled forms were analyzed. Results: Out of the total 50 cases evaluated, 60 (60%) were males and 20(40%) were females. The 28 patients (56%) had a family history of diabetes. The prevalence of the associated diabetic complications was as follows viz. Hypertension (17.65%), IHD (1.47%), retinopathy (17.65%), nephropathy (7.35%), Neuropathy (47.06%), Stroke (5.88%) and CHF (2.94%). The overall utilization pattern of drugs were as follows viz. anti-diabetics (28%), anti-hypertensive (9%), antiplatelets (4%), lipid lowering agents (7%), vitamins and minerals (17%),GI drugs (14%), antimicrobials(6%). Among anti-diabetic drugs 48(96%) biguanides and 44(88%) of sulfonylureas classes of antidiabetic drugs were utilized. Likewise, preferred drugs for the management of hypertension, IHD, dyslipidemia, and neuropathy were Diuretics (25.93%), Clopidogrel (66.66%), Atorvastatin (100%), and Acetominophine (67.74%) respectively. Conclusion: The prevalence of micro and macro complications among type 2 diabetic patients was found to be high. Although polypharmacy was observed, drug utilization patterns can be rational owing to the higher prevalence of complications. Patient are not aware of the severity of the disease so complication makes the therapeutic more challenging. Patient education on disease severity and healthcare professionals need more focus on disease complications and severity to treat the disease earlier to improve patient health outcomes.

A study of drug prescription patterns, disease-therapy awareness and of quality of life among patients with migraine visiting a tertiary care hospital in Mumbai, India

Background: Migraine is one of the leading causes of disability globally. There is scarcity of data on disease -therapy awareness and its correlation with demographic factors. Hence its was of interest to assess those along with quality of life in these patients. Methods: A Cross-sectional observational study was conducted in108 patients attending the Neurology and headache OPD at a tertiary care hospital between March 2017 and August 2018. Disease and therapy awareness among patients were evaluated using validated questionnaires and correlation was done with demographic factors. The severity of the disease and its impact on the patients' quality of life were assessed using the migraine disability assessment scale. Results: The mean disease and therapy awareness scores were 9 and 7 respectively. Both had a positive correlation with education and socioeconomic factors. The quality of life was affected moderately in 48.1% of the patients followed by severely 32.4% of the patients. The average number of drugs prescribed per encounter was 3.05. NSAIDS were used more commonly as compared to Triptans for acute attacks. Conclusions: The disease and therapy awareness were fair and positively correlated with education/ socioeconomic status. However, a significant disability was found among patients even with treatment. This highlights the need for educating these patients for effectively controlling the disability.

Assessment of prescription completeness and drug use pattern using WHO prescribing indicators in private community pharmacies in Addis Ababa: a cross-sectional study

BackgroundHealthcare systems in both developing and developed countries were not free from prescription errors. One of the effects of prescription errors is irrational prescribing. According to the estimation of the World Health Organization (WHO), greater than 50% of medicines are prescribed and dispensed irrationally. On the other hand, research on drug use patterns in the private healthcare sector is scarce. This study aimed to assess prescription Completeness and Drug use Pattern using WHO prescribing indicators in Private Community Pharmacies in Lemi-Kura sub-city.MethodsBased on the WHO prescribing indicators, a retrospective cross-sectional technique was employed to examine the completeness and drug-prescription patterns. The study was conducted from April to May 2021. Prescriptions, kept for 1 year that was prescribed from March 2020 to March 2021, by private healthcare sectors, were analyzed. A systematic random sampling technique was employed to select prescriptions obtained from private health facilities. Data were analyzed using SPSS® version 26.0 software.ResultsOf a total of 1000 prescriptions, 1770 drugs were prescribed and the average number of drugs per prescription was 1.77. Prescriptions for two drugs account for 38% of these, while prescriptions for three drugs account for 15%. Age, sex, and card number were written on 99.0%, 99.2%, and 41.8% of prescriptions, respectively. The patient's name was written on every prescription. Even though the availability of other therapeutic information on the prescription made it appear greater, only 44.2% of prescriptions included the dosage form of medications. The generic name was used for the majority of the medications (67.8%). Furthermore, assuming that each prescription was for a single patient, 71% of patients received antibiotics, and 2% received injectable medicines. The National List of Essential Medicines-Ethiopia was used in 99.6% of the prescriptions.ConclusionsOn the basis of the finding of this study, the prescribing and prescription completeness indicator showed deviation from the standard recommended by WHO. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing prescription errors in Ethiopia. Hence, in-service training for prescribers should be provided to improve adherence to basic prescription writing.

Evaluating Drug Prescription Patterns in Undiagnosed Common Variable Immunodeficiency Patients.

To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis. We conducted a nested case-control study, identifying all individuals (n=130 cases) diagnosed with CVID in Denmark (1994-2014) and 45 age- and sex-matched population controls per case (n=5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals. In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) (p<0.001). CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies.

Prescription Pattern of Different Groups of Antibiotics at Out Patient Department of a Tertiary Medical College Hospital in Dhaka City

Background: Drugs prescription pattern is very important at outpatient department in the tertiary care hospital. Objective: The purpose of the present study was to evaluate the distribution of patients and antibiotic prescribing trends in OPD of a Tertiary Medical College hospital. Methodology: This cross-sectional study was undertaken in the medicine, surgery, gynaecology &amp; obstetrics and paediatrics Out Patient Department of Shaheed Suhrawardy Medical college hospital, Dhaka. The duration of the study period was 5 weeks (25th March, 2017 to 29th April, 2017). The study was designed to obtain information regarding prescribing pattern of drugs by physicians and also to analyze basal information of the prescription. The prescription were observed from the hospital’s OPD and few prescriptions were from each unit. Results: A total 320 prescription were observed from the hospital’s OPD where 80 prescriptions were from each unit. The mean age of the patients was 24.50±14.976 years. The most commonly prescribed antibiotics at medicine OPD was Cephalosporin which was 19(51.4%) cases followed by others antibiotics and azithromycin which was 9(24.3%) cases and 8(21.6%) cases respectively. In surgery OPD, the most commonly used antibiotics were flucloxacillin and cephalosporin which was 66(82.5%) cases and 24(30.0%) cases respectively. In Gynae &amp; obstetrics OPD, the most commonly prescribed antibiotics were quinolones as well as other groups of antibiotics which were 23(46.0%) cases and 27(54.0%) cases respectively. Conclusion: In conclusion most commonly used antibiotic are Cephalosporin, azithromycin and Flucloxacillin in different OPD of the hospital. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):54-58

Prescription audit and drug interactions of anti-diabetic drugs at Outpatient Department at a tertiary care teaching hospital in Eastern Nepal

Type 2 diabetes mellitus (T2DM) is the third major non-communicable disease in Nepal. Drug utilization studies help in reducing the patient’s expenditure, adverse drug reactions and drug-drug interactions. It would help in understanding of consumption of drugs including newer ones. Objective was to analyze the prescribing pattern and drug interactions of anti-diabetic drugs. A prospective cross-sectional study was conducted among patients having T2DM at Birat Medical College and Teaching Hospital (BMCTH), Biratnagar, Nepal from May 2019- August 2019. WHO core drug use indicators were used to analyze the obtained data. Descriptive statistics like mean, standard deviation, frequency and percentage were calculated using Microsoft Excel 2013. Out of 200 patients, 104 (52.0%) were females and 49.5% were from the age group of 41-60 years. Average number of drugs per patient was 5.74. Biguanides (40.7%) were the most common prescribed oral antidiabetic drugs followed by Sulfonylureas (23.3%). The percentage of drugs prescribed by generic name and from WHO essential drug list was 0.6% and 15.4% respectively. A total of 95 (47.5%) patients has potential drug-drug interaction (DDI) and it was most common in the age group of 41-60 years (43.2%). Among 95 DDI, Metformin+Amlodipine ranked in 1st position (16 encounters). Polypharmacy was prevalent in the present study. Metformin was the most commonly prescribed anti-diabetic drug. The percentage of drugs from the WHO essential medicine list and prescribed by generic names was low. Prevalence of potential DDI was high.

Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs.

Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health problems such as depression and anxiety. This study aims to investigate the prescribing pattern of psychotropic drugs in patients with common mental disorders which might be altered during the pandemic and also whether the pandemic could alter their quality of life (QOL) and medication adherence. After prior ethical approval, a descriptive cross-sectional drug utilization study (DUS) of 200 prescriptions was undertaken to evaluate the pattern of psychotropic drug usage as per WHO (World Health Organization)/International Network of Rational Use of Drugs (INRUD) guidelines. The correlation of the average number of drugs per prescription with QOL was observed. The correlation of adverse drug reactions (ADRs) with medication adherence was also analyzed. The average number of drugs per prescription during the pre-COVID-19 and COVID-19 period was estimated to be 2.48 and 2.96. The percentage of drugs prescribed by generic name in the two different periods (pre-COVID-19 and COVID-19) was 97.40 and 95.77%. The percentage of drugs prescribed from the list of essential medicines was 89.40 and 85.12%, respectively. The percentage of prescriptions with injections was 0.45% and 0.53%, respectively for the two periods. The QOL during the COVID-19 pandemic was found to be negatively correlated to the average number of drugs per prescription (correlation coefficient = -0.61) and medication adherence was found to be poor in patients who developed ADRs with the drugs prescribed (p-value of 0.001). In the tertiary care hospital described, rational drug prescribing was followed. Increase in the number of drugs per prescription was found to be associated with poor QOL and the development of ADRs led to medication nonadherence in the patients. Further studies with larger sample sizes are needed to confirm these results. How to cite this article: Kumar A, Halder S, Srivastava S, et al. Increased Pill Burden and Adverse Effects of Psychotropics Correlated with Poor Quality of Life and Medication Nonadherence: A Cross-sectional Drug Utilization Study at a Tertiary Care Hospital in Delhi during COVID-19 Pandemic. J Assoc Physicians India 2023;71(9):14-18.

A study of drug prescribing pattern among pregnant women in the obstetrics and gynecology outpatient department at a rural tertiary care teaching hospital of Maharashtra

Abstract: CONTEXT: Antenatal period is the crucial period in women. It is very much essential to know the rationality of drug use and the patients’ knowledge in this aspect as evident from various literature. AIMS: The aim was to evaluate the prescribing pattern among pregnant women visiting in the obstetrics and gynecology (OBGY) outpatient departments (OPD) teaching hospital and to appraise their knowledge regarding safe drug use during pregnancy. SETTINGS AND DESIGN: This was descriptive, cross-sectional, observational drug prescription study in OBGY OPD. SUBJECTS AND METHODS: In a sample size of 200 pregnant women, socioeconomic parameters were assessed. Prescriptions were analyzed as per the World Health Organization (WHO) core prescribing indicators. The knowledge of the patients regarding safe drug use during pregnancy was assessed through the standard questionnaire. STATISTICAL ANALYSIS USED: Analysis was primarily descriptive with values mainly expressed as percentages using Microsoft Excel. RESULTS: Majority of patients were from the rural area depending on the peripheral/primary health services for OBGY conditions. Most of pregnant women were in the age group of 21–25 years. In terms of WHO prescribing indicators, it was evident that prescribing pattern of health-care providers in the study site was irrational. The knowledge of study participants regarding safe drug use during pregnancy was of mixed in terms of defined parameters. The most commonly prescribed classes of drugs in pregnant women were vitamins, followed by iron and calcium preparations. CONCLUSIONS: This study helped to conclude the irrational drug prescription pattern and estimation of attitude and awareness among this vulnerable patient group about the drugs and possible risk associated with the medications in this clinically important phase.

Renin‐angiotensin-aldosterone system inhibitors and mortality risk in elderly patients with atrial fibrillation. Insights from the nationwide START registry

BackgroundArterial hypertension is the most common cardiovascular comorbidity in atrial fibrillation (AF). Few studies investigated management strategies of hypertension in AF. Materials and methodsWe included 5769 AF patients on oral anticoagulants from the nationwide ongoing Italian START registry. We investigated the prescription of antihypertensive drugs and mortality risk. Subgroup analyses according to sex and major cardiovascular comorbidities were performed. ResultsMean age was 80.8 years, 46.1% were women; 80.3% of patients were hypertensive. Furosemide (30.1%) was the most frequent diuretic followed by hydrochlorothiazide (15.4%) and potassium canrenoate (7.9%). 61.1% received β-blockers: 34.2% bisoprolol, 6.2% atenolol. Additionally, 36.9% were on angiotensin converting enzyme inhibitors (ACE-I): ramipril (20.9%), enalapril (5.3%) and perindopril (2.8%); 31.7% were on angiotensin receptors blockers (ARBs): valsartan (7.6%) and irbesartan (6.4%). Amlodipine and lercanidipine were prescribed in 14.0% and 2.3%, respectively. ACE-I (p < 0.001), α-blockers (p = 0.020) and Dihydropyridines calcium channel blockers (p = 0.004) were more common in men, while ARBs (p = 0.008), thiazide diuretics (p < 0.001) and β-blockers (p < 0.001) in women.During 22.61 ± 17.1 months, 512 patients died. Multivariable Cox regression analysis showed that ACE-I (Hazard ratio [HR] 0.758, 95% Confidence Interval [95%CI] 0.612–0.940, p = 0.012) and ARBs (HR 0.623, 95%CI 0.487–0.796, p < 0.001) inversely associated with mortality. ACE-I/ARBs inversely associated with mortality in both sexes and in patients with diabetes. This associastion was evident for ACE-I in patients with previous cardiovascular disease, and for ARBs in HF. ConclusionA lower mortality risk was found in AF patients on ACE-I/ARBs. Different prescription patterns of antihypertensive drugs between men and women do exist.

A prospective observational study of prescription pattern of antihypertensive drugs in general medicine outpatient department of associated hospital RUHS CMS, Jaipur

Background: The increasing prevalence of hypertension is attributed to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress. The aim of study is the prescribing pattern and the consumption of antihypertensive drugs in isolated hypertensive patients and in hypertensive patients with different co-existing morbidities. Methods: The present study is a Prospective observational study. The study was conducted at Medicine Department of associated hospital of RUHS College of Medical Sciences, Jaipur. Results: A total of 965 patients having hypertension were analyzed, in that 556 patients were male and 409 patients were female. In hypertension patients, angiotensin receptor blockers ARB, diuretics and β- blockers (29.90%) were mostly used classes in three drug therapy. Whereas telmisartan, hydrochlorothiazide and metoprolol (35.05%) were mostly prescribed. Drugs. In hypertension patients, angiotensin receptor blockers ARB, diuretics, β- blockers and calcium channel blockers (56.67%) and calcium channel blockers, angiotensin converting enzyme inhibitors, β-blockers and diuretics (43.33%) were used classes in four drug therapy. Whereas Telmisartan, Hydrochlorothiazide, Nebivolol and Amlodipine (62.5%) were mostly prescribed drugs. Hypertensive Patients with Comorbidity were found in higher prevalence with 276 hypertensive patients (28.60%) along with Diabetes Mellitus most commonly found and 389 hypertensive patients (40.31%) were found to be with No Comorbidity. Conclusions: Present results reveal that antihypertensive medication adherence to JNC-8 recommendations is suboptimal. Therefore, physicians should follow JNC-8 guidelines to improve the patients care because suboptimal adherence leads to adverse clinical outcomes. The present study demonstrated that physicians are not completely adhering to standard guidelines while treating hypertension with co-morbid conditions.

Prescription Pattern of Anti-Plateletic Drugs, Clinical Manifestations and Risk Factors in Cerebro Vascular Accident: A Prospective Observational Study

Aim: The aim and objective of the study is to evaluate the prescription pattern of anti-plateletic agents used in the treatment of stroke and clinical symptoms and risk factors, among hospitalized stroke patients. Materials and Method: A six-month prospective observational study that was carried out in the neurology department. A standard procedure was followed for the documentation and analysis of all the data. A total of 120 patients selected for the study who satisfying the inclusion and exclusion criteria. Results: Out of total 120 patients, the most prevalent type of stroke was found to be ischemic stroke of 92%. Females were found mostly to be diagnosed by stroke. Aspirin (65%) was found to be the most common anti-plateletic agent used in the treatment of stroke followed by clopidogrel and its combination. Majority of patients experienced slurred speech (37.5%), followed by weakness as the clinical presentation of stroke. Hypertension (49.1%) was found to be the most prevalent risk factor of stroke followed by diabetes mellitus. Conclusion: The study provides a concise summary of the clinical symptoms, risk factors, and prescription pattern of anti-platelet therapy in stroke patients. By proper identification and rectification of the strong contributable risk factor for stroke may lead to a good prognosis of treatment of stroke.

Drug utilization pattern in patients of upper respiratory tract infections in pediatrics outpatient department at a tertiary care hospital

Background: Upper respiratory tract infections are the most common and frequently occurring infections in the pediatric population. These infections include conditions like common cold, laryngitis, pharyngitis, tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Young children have an average of 6-8 colds per year, however 10 -15% of children have at least 12 infections per year. This study concentrates on prescription pattern of Upper Respiratory Tract Infections in children. primary objective was to study the prescription pattern of drugs used in URTI in pediatric outpatient department and the secondary objective was to determine whether the drugs being prescribed comply with those listed in the National list of essential medicines. Methods: This study was a Cross-sectional, observational study conducted at the Pediatric Outpatient Department in a tertiary care hospital, India. The data was collected from patients visiting Pediatrics OPD from June 2021 to December 2021 after taking written informed consent. Sample size was calculated to be 303. Results: Total 943 drugs were prescribed for 303 patients with an average of 3.11±1.15 drugs per prescription. Most common class of drugs prescribed was Antipyretics of which Paracetamol was the most common drug. Antibiotics were prescribed for 19.80% patients &amp; combination of Amoxicillin and Clavulanic acid was the most common antibiotic prescribed. 68.29% drugs were prescribed by generic name. 43.16% drugs were prescribed from National List of Essential Medicines 2015. Conclusions: The study revealed that the majority of children suffering from URTI were below 5 years of age. Our study highlighted the prescribing.

Drug Prescriptions during Pregnancy in Lombardy: Temporal Trends and the Impact of the Onset of the COVID-19 Pandemic

This population-based study aimed at providing an overview of drug prescription patterns during pregnancy in the Italian region of Lombardy from 2010 to 2020. The cohort consisted of 780,075 deliveries identified from the regional healthcare utilization databases. The prevalence of drugs’ dispensed prescriptions was estimated as the proportion of pregnant women with at least one prescription out of the total deliveries over the entire pregnancy and by trimester. Drugs were classified according to the Anatomical Therapeutic Chemical code. In addition, interrupted time series analysis was conducted to investigate temporal trends of antibiotics’ use during the onset of the COVID-19 pandemic. A total of 497,515 women (63.8%) used at least a drug, including vitamins and minerals, at some point during pregnancy. Vitamins, minerals, and anti-anaemic preparations were prescribed in 20.8%, 13.3%, and 18.3% of deliveries over the trimesters of pregnancy. Folic acid was the most prescribed drug, with about one woman out of four, followed by iron preparations, progestogen, and antibiotics (prescription rate, respectively: 15.9%, 10.2%, and 9.8%). A decreasing trend in the dispensing of antibiotics emerged during the entire study period; however, a significant further decrease following the spread of the pandemic was observed. Further evidence is needed to monitor the use of drugs during pregnancy, determinants, and implications.

A Study of Drug Use in the Outpatient Pediatric Department of a Tertiary Care Hospital in Jammu and Kashmir

BACKGROUND&#x0D; The health care system around the world is concerned about rational drug use. To achieve this goal, the more vulnerable pediatric population necessitates additional attention. The study's objectives were to determine the most prevalent diseases and medications administered, as per WHO recommendations, by looking at prescription trends and the ailments for which they were prescribed.&#x0D; Objective&#x0D; The objective of this study was to find drug use in the outpatient pediatric department of a tertiary care hospital in Jammu and Kashmir.&#x0D; METHODS&#x0D; This four-month prospective study was undertaken in the paediatrics department of a tertiary care hospital in Jammu and Kashmir. The Institutional Ethical Committee gave its nod to the investigation, which was then carried out. The parent's or guardian's consent was obtained after discussion and explanation. The patient's and the prescriber's privacy were protected. Every pediatric prescription (from newborn to 12 years old) from the outpatient, inpatient, and critical care units was included in the research.&#x0D; RESULTS&#x0D; There were 498 prescriptions in total that were randomly collected and studied. There were a total of 1895 prescriptions, with an average of 4.01 per encounter. Prescriptions from the WHO's essential drug list (666) accounted for 35.14 percent of all prescriptions. There were 397 prescriptions written for antibiotics in total. A total of 79.72 percent of patient encounters involved an antibiotic prescription. The prescribed injections were used in 26.2% of the encounters.&#x0D; CONCLUSION&#x0D; With all the indicators, this study gives a positive outlook on drug use, especially for those on the EDL (Essential Drug List). It is possible to improve health care through regular auditing, continuous medical education, and evidence-based medicine (EBM). Drug prescribing patterns in a pediatric outpatient department have been analyzed in this research. To summarize, the role of the clinical pharmacist is critical in pediatrics, both as an integral part of the care team and in clearing up any confusion about the appropriate use of medications. As a pediatric patient, proper drug management is even more critical than for an adult. The prescribing patterns were improved, substantial issues with patients' or caretakers' grasp of consultant instructions were found, and even the financial burden on the patient was lessened with the aid of the WHO core indicators.